Last updated on December 28th, 2023
Here we’ll create a scenario-based sample nursing care plan for Multiple Sclerosis (MS). It will include nursing assessment, nursing diagnosis, desired outcome/goal, and nursing interventions with rationale for MS.
Multiple Sclerosis Case Scenario
A 27-year old female presents to the ED with complaints of blurry vision, fatigue, and weakness. For the last 2 months, the patient has noticed a decrease in coordination during her martial arts sessions.
During her most recent boxing session, she had to stop halfway through because she was so fatigued she couldn’t carry on. When the fatigue did not improve over the subsequent days, she decided to come to the hospital.
The patient is alert and oriented and follows commands appropriately. The patient complains of a headache and blurry vision and upon assessment of the eyes, mild nystagmus is noted bilaterally. She has equal strength in both limbs but movements are weak and tremors are noted.
The patient also reports numbness and tingling in her upper and lower extremities. During the assessment, the patient reveals that fine motor movements have been more difficult than usual and she has had trouble picking up small items.
Indeed, when the nurse asks the patient to pick up a pen on the desk, the patient struggles and it takes a few tries to successfully pick it up.
The patient’s blood work is unremarkable. She is subsequently taken for an MRI where demyelination and plaques are discovered in the corpus callosum.
The patient is admitted to the hospital for Multiple Sclerosis.
#1 Sample Multiple Sclerosis (MS) Nursing Care Plan – Impaired physical mobility
Nursing Assessment
Subjective Data:
- The patient reports fatigue and weakness
Objective Data:
- Weakness and tremors are noted upon assessment
- Fine motor movements are altered
Nursing Diagnosis
Impaired physical mobility related to neurological impairment secondary to multiple sclerosis as evidenced by weakness, fatigue, and tremors
Goal/Desired Outcome
Short-term goal: By the end of the shift, the patient will be able to list a few mobility aids that could assist her now or in the future
Long-term goal: The patient will retain the ability to perform ADLs at home
Nursing interventions with rationales for MS – Impaired physical mobility
| Nursing Interventions | Rationales |
| Perform specialized neurological exams to establish a baseline and track improvement or worsening | 3 tests or outcome measures, in particular, are used to assess MS 1. Nine hole peg test (tests the arms) 2. Timed 25-foot walk test (tests the legs) 3. PASAT or paced auditory serial addition test (tests the capacity and rate of information processing |
| Assess the cranial nerves, muscle strength, and reflexes | This assesses for changes in movement, balance, vision, speech, etc. |
| Utilize mobility aids as needed | Depending on the patient’s level of disability, aids such as a cane, walker, or wheelchair may be required to facilitate mobility. |
| Educate the patient about fall prevention and safety | Interventions such as wearing non-skid socks, adhering to loose rugs, or removing clutter can help improve safety at home |
#2 Sample Multiple Sclerosis (MS) Nursing Care Plan – Fatigue
Nursing Assessment
Subjective Data:
- The patient reports fatigue and weakness
- The patient is unable to complete her normal exercise regimen
Objective Data:
- Weakness and tremors are noted upon assessment
Nursing Diagnosis
Fatigue related to demyelinating disease of the central nervous system as evidenced by fatigue, weakness, and inability to perform regular physical activities
Goal/Desired Outcome
Short-term goal: By the end of the shift the patient will be able to state the importance of tracking her fatigue levels and using a validated fatigue scale
Long-term goal: The patient will successfully manage her fatigue with lifestyle changes and complementary therapies
Nursing interventions with rationales for MS – Fatigue
| Nursing Interventions | Rationales |
| Assess and monitor fatigue using a validated fatigue scale | Using a scale can detect a worsening or improvement in the level of fatigue |
| Encourage the patient to rest frequently, utilizing support systems to delegate tasks and limit activity | Frequent rest and reliance on support systems will be necessary as the disease progresses |
| Consider the use of a service dog | A service dog can increase independence and lessen fatigue by performing necessary tasks for the patient |
| Schedule ADLs in the morning | MS patients generally have the most energy in the morning |
| Coordinate with physical therapy | PT is important for improving muscle strength, balance, coordination, and gait |
| Coordinate with occupational therapy | OT is important for achieving greater independence with activities of daily living |
#3 Sample Multiple Sclerosis (MS) Nursing Care Plan – Knowledge deficit
Nursing Assessment
Subjective Data:
- The patient reports fatigue, weakness, and loss of coordination
Objective Data:
- Demyelination and plaques seen on MRI
- New diagnosis of multiple sclerosis
Nursing Diagnosis
Deficient knowledge related to new neurological diagnosis as evidenced by demyelination and plaques seen on MRI and symptoms of fatigue, weakness, and loss of coordination
Goal/Desired Outcome
Short-term goal: By the end of the shift the patient will be able to verbalize an understanding of multiple sclerosis and a few possible treatment options
Long-term goal: The patient will actively participate in a treatment regime and verbalize hope for the future
Nursing interventions with rationales for MS – Knowledge deficit
| Nursing Interventions | Rationales |
| Administer medications for fatigue | Medications such as Methylphenidate (Ritalin), which is a CNS stimulant, and Amantadine (Symmetrel), which is an antiviral, can improve fatigue in patients with MS |
| Administer steroids | Although ineffective long-term, steroids can prevent edema from forming at the sclerotic plaques during an acute exacerbation. Examples include prednisone (Deltasone) and dexamethasone (Decadron) |
| Administer immunomodulating agents | These types of drugs work by blocking the action of certain cytokines, preventing an autoimmune reaction and subsequent inflammation. Examples include azathioprine (Imuran), methotrexate (Mexate), and Dimethyl Fumarate (Tecfidera). |
| Consider plasmapheresis | Plasmapheresis is a process by which the blood plasma is removed and replaced with donor plasma. This is thought to remove inflammatory factors and lessen inflammation |
| Consider deep brain stimulation for severe MS-related tremors | Deep brain stimulation can help with tremors related to MS |
| Consider Botulinum toxin to decrease spasticity, muscle stiffness, and involuntary movements | Injections of botulinum toxin block acetylcholine release from the nerve, thus relaxing the muscle |
Conclusion
To conclude, here we have formulated a scenario-based nursing care plan for Multiple Sclerosis (MS). Prioritized nursing diagnoses are impaired physical mobility, fatigue, and knowledge deficit.
Additionally, this sample nursing care plan for MS includes nursing assessment, NANDA nursing diagnosis, and interventions with rationales.
See Also
Chronic Pain Nursing Diagnosis and Nursing Care Plans
Acute Pain Nursing Care Plans and Nursing Diagnosis
Risk for Infection Nursing Care Plans
Recommended Reading & References
Ackley, B., Ladwig, G., Makic, M., Martinez-Kratz, M., & Zanotti, M. (2020). Nursing Diagnoses Handbook: An Evidence-based Guide to Planning Care (12th ed.). Elsevier.
Herdman, T., Kamitsuru, S. & Lopes, C. (2021). NURSING DIAGNOSES: Definitions and Classifications 2021-2023 (12th ed.). Thieme.
Swearingen, P. (2016). ALL-IN-ONE CARE PLANNING RESOURCE (4th ed.). Elsevier/Mosby.
